Bill Text: TX HB997 | 2013-2014 | 83rd Legislature | Comm Sub
Bill Title: Relating to health plan and health benefit plan coverage for abortions.
Sponsorship: Partisan Bill (Republican 57)
Status: (Introduced - Dead) 2013-05-04 - Considered in Calendars [HB997 Detail]
Download: Texas-2013-HB997-Comm_Sub.html
| 83R6837 TJS-F | |||
| By: Smithee, Flynn, Thompson of Brazoria, | H.B. No. 997 | ||
| Bonnen of Brazoria, Bonnen of Galveston, | |||
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| relating to health plan and health benefit plan coverage for | ||
| abortions. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Title 8, Insurance Code, is amended by adding | ||
| Subtitle K to read as follows: | ||
| SUBTITLE K. FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT | ||
| CHAPTER 1671. LEGISLATIVE CONSIDERATIONS | ||
| Sec. 1671.001. CONSTITUTIONALITY OF PATIENT PROTECTION AND | ||
| AFFORDABLE CARE ACT. This subtitle does not constitute an | ||
| acknowledgment by the legislature of the legitimacy of the Patient | ||
| Protection and Affordable Care Act (Pub. L. No. 111-148) as a | ||
| constitutional exercise of the power of the United States Congress. | ||
| CHAPTER 1672. COVERAGE FOR ABORTION; PROHIBITIONS AND REQUIREMENTS | ||
| Sec. 1672.001. DEFINITIONS. In this chapter: | ||
| (1) "Abortion" has the meaning assigned by Section | ||
| 171.002, Health and Safety Code. | ||
| (2) "Health benefit exchange" means an American Health | ||
| Benefit Exchange administered by the federal government or created | ||
| under Section 1311(b) of the Patient Protection and Affordable Care | ||
| Act (42 U.S.C. Section 18031(b)). | ||
| (3) "Qualified health plan" has the meaning assigned | ||
| by Section 1301(a) of the Patient Protection and Affordable Care | ||
| Act (42 U.S.C. Section 18021(a)). | ||
| Sec. 1672.002. PROHIBITED COVERAGE THROUGH HEALTH BENEFIT | ||
| EXCHANGE. (a) A qualified health plan offered through a health | ||
| benefit exchange may not provide coverage for an abortion other | ||
| than coverage for an abortion performed when a life-threatening | ||
| physical condition exists, based on reasonable medical judgment, | ||
| that complicates the medical condition of the pregnant woman or | ||
| pregnant minor to an extent that the abortion of her pregnancy is | ||
| necessary to prevent her death or a serious risk of substantial and | ||
| irreversible physical impairment of a major bodily function of the | ||
| woman or minor, other than a psychological or emotional condition. | ||
| (b) Subsection (a) does not authorize coverage for an | ||
| abortion based on a potential future medical condition that may | ||
| result from a voluntary act of the woman or minor. | ||
| (c) This section does not prevent a person from purchasing | ||
| optional or supplemental coverage for abortions under a health | ||
| benefit plan other than a qualified health plan offered through a | ||
| health benefit exchange. | ||
| SECTION 2. Subtitle A, Title 8, Insurance Code, is amended | ||
| by adding Chapter 1218 to read as follows: | ||
| CHAPTER 1218. COVERAGE FOR ABORTION; PROHIBITIONS AND REQUIREMENTS | ||
| Sec. 1218.001. DEFINITION. In this chapter, "abortion" has | ||
| the meaning assigned by Section 171.002, Health and Safety Code. | ||
| Sec. 1218.002. APPLICABILITY OF CHAPTER. (a) This chapter | ||
| applies only to a health benefit plan that provides benefits for | ||
| medical or surgical expenses incurred as a result of a health | ||
| condition, accident, or sickness, including an individual, group, | ||
| blanket, or franchise insurance policy or insurance agreement, a | ||
| group hospital service contract, or an individual or group evidence | ||
| of coverage or similar coverage document that is offered by: | ||
| (1) an insurance company; | ||
| (2) a group hospital service corporation operating | ||
| under Chapter 842; | ||
| (3) a fraternal benefit society operating under | ||
| Chapter 885; | ||
| (4) a stipulated premium company operating under | ||
| Chapter 884; | ||
| (5) an exchange operating under Chapter 942; | ||
| (6) a health maintenance organization operating under | ||
| Chapter 843; | ||
| (7) a multiple employer welfare arrangement that holds | ||
| a certificate of authority under Chapter 846; or | ||
| (8) an approved nonprofit health corporation that | ||
| holds a certificate of authority under Chapter 844. | ||
| (b) This chapter applies to group health coverage made | ||
| available by a school district in accordance with Section 22.004, | ||
| Education Code. | ||
| (c) Notwithstanding Section 172.014, Local Government Code, | ||
| or any other law, this chapter applies to health and accident | ||
| coverage provided by a risk pool created under Chapter 172, Local | ||
| Government Code. | ||
| (d) Notwithstanding any provision in Chapter 1551, 1575, | ||
| 1579, or 1601 or any other law, this chapter applies to: | ||
| (1) a basic coverage plan under Chapter 1551; | ||
| (2) a basic plan under Chapter 1575; | ||
| (3) a primary care coverage plan under Chapter 1579; | ||
| and | ||
| (4) basic coverage under Chapter 1601. | ||
| (e) Notwithstanding Section 1501.251 or any other law, this | ||
| chapter applies to coverage under a small or large employer health | ||
| benefit plan subject to Chapter 1501. | ||
| (f) Notwithstanding Section 1507.003 or 1507.053, this | ||
| chapter applies to a standard health benefit plan provided under | ||
| Chapter 1507. | ||
| Sec. 1218.003. COVERAGE BY HEALTH BENEFIT PLAN. (a) Except | ||
| as provided by Subsection (b), a health benefit plan may provide | ||
| coverage for abortion only if: | ||
| (1) the coverage is provided to an enrollee separately | ||
| from other health benefit plan coverage offered by the health | ||
| benefit plan issuer; | ||
| (2) an enrollee pays separately from, and in addition | ||
| to, the premium for other health benefit plan coverage a premium for | ||
| coverage for abortion; and | ||
| (3) an enrollee provides a signature for coverage for | ||
| abortion, separately and distinct from the signature required for | ||
| other health benefit plan coverage offered by the health benefit | ||
| plan issuer. | ||
| (b) Notwithstanding Subsection (a), a health benefit plan | ||
| may provide coverage for an abortion performed when a | ||
| life-threatening physical condition exists, based on the | ||
| performing physician's reasonable medical judgment, that | ||
| complicates the medical condition of a pregnant enrollee to the | ||
| extent that the abortion of her pregnancy is necessary to prevent | ||
| her death or a serious risk of substantial and irreversible | ||
| physical impairment of a major bodily function of the enrollee, | ||
| other than a psychological or emotional condition. | ||
| (c) Subsection (b) does not authorize coverage for an | ||
| abortion based on a potential future medical condition that may | ||
| result from a voluntary act of the enrollee. | ||
| Sec. 1218.004. CALCULATION OF PREMIUM. (a) A health | ||
| benefit plan issuer that provides coverage for abortion shall | ||
| calculate the premium for the coverage so that the premium fully | ||
| covers the estimated cost of abortion per enrollee, determined on | ||
| an average actuarial basis. | ||
| (b) In calculating a premium under Subsection (a), the | ||
| health benefit plan issuer may not take into account any cost | ||
| savings in other health benefit plan coverage offered by the health | ||
| benefit plan issuer that is estimated to result from coverage for | ||
| abortion, including costs associated with prenatal care, delivery, | ||
| or postnatal care. | ||
| (c) A health benefit plan issuer that provides coverage | ||
| other than coverage for abortion may not provide a premium discount | ||
| to or reduce the premium for an enrollee for coverage other than | ||
| coverage for abortion on the basis that the enrollee has health | ||
| benefit plan coverage for abortion. | ||
| Sec. 1218.005. NOTICE BY ISSUER. A health benefit plan | ||
| issuer that provides coverage for abortion shall at the time of | ||
| enrollment in the health benefit plan provide each enrollee with a | ||
| notice that: | ||
| (1) coverage for abortion is optional and separate | ||
| from other health benefit plan coverage offered by the health | ||
| benefit plan issuer; | ||
| (2) the premium cost for coverage for abortion is a | ||
| premium paid separately from, and in addition to, the premium for | ||
| other health benefit plan coverage offered by the health benefit | ||
| plan issuer; and | ||
| (3) the enrollee may enroll in a health benefit plan | ||
| that provides coverage other than coverage for abortion without | ||
| obtaining coverage for abortion. | ||
| Sec. 1218.006. ACCEPTANCE OR REJECTION OF SUPPLEMENTAL | ||
| COVERAGE BY EMPLOYEES AND GROUP MEMBERS. If a small or large | ||
| employer health benefit plan or group health benefit plan offers | ||
| coverage for abortion, the employer offering the employee health | ||
| benefit plan or the entity offering the group health benefit plan | ||
| shall provide each employee or group member with an opportunity to | ||
| accept or reject supplemental coverage for abortion: | ||
| (1) at the beginning of employment or when the group | ||
| member's coverage begins, as applicable; and | ||
| (2) at least one time in each calendar year after the | ||
| first year of employment or group coverage. | ||
| SECTION 3. This Act applies only to a qualified health plan | ||
| offered through a health benefit exchange or a health benefit plan | ||
| that is delivered, issued for delivery, or renewed on or after | ||
| January 1, 2014. A qualified health plan offered through a health | ||
| benefit exchange or a health benefit plan that is delivered, issued | ||
| for delivery, or renewed before January 1, 2014, is governed by the | ||
| law as it existed immediately before the effective date of this Act, | ||
| and that law is continued in effect for that purpose. | ||
| SECTION 4. This Act takes effect September 1, 2013. | ||
